General Surgery
By Thomas H. Lewis, MD
About 20 years ago when the laparoscopic gallbladder procedure was first perfected, there was a surge in the number of gallbladder removal operations in the United States. It made sense there would be an increase since the new procedure was much safer for patients and the recovery time was greatly reduced. Recently, surgeons are seeing another increase in the number of gallbladder removals, both nationwide and in our local community.
The patients showing symptoms of gallbladder disease are younger than they ever were before. Gallstones can appear in a person of any age, but historically the average age when they became a problem was in a person’s forties, fifties or sixties. Today, patients with symptomatic gallstones tend to be in their thirties or forties. Surgeons today have even had to remove gallbladders from teenagers. What is going on?
Gallbladder disease is linked to two health problems that are on the rise in young people: obesity and diabetes. So it is not a surprise that numbers are trending upwards. The gallbladder is a little sac that stores bile from the liver, a substance which helps the body digest fat. It is believed that high-fat diets contribute to the bile becoming over-saturated, causing gallstones to form.
Ironically, rapid weight loss can also increase the likelihood of gallstones. Fad diets where people drop significant weight in short periods of time are putting people at risk and women have a slightly higher risk than men. Genetics can also play a role. It is estimated that about 20-25 million Americans have gallbladder disease.
How does a patient know that they may have gallbladder disease? Symptoms may be as minimal as occasional indigestion and frequent belching. Pain in the mid or upper right portion of the abdomen after eating (especially fatty or greasy foods) is the most common symptom. In some patients, gallstones may be present and completely asymptomatic for many years. Larger stones become problematic when they block the gallbladder from releasing the bile. Smaller stones can slip into the bile duct and cause pancreatitis or other life-threatening situations.
Eating a healthy diet and exercising can help prevent the formation of gallstones. Once you have gallstones the only way to get rid of them is surgery to remove the gallbladder. Most patients are candidates for the laparoscopic procedure, where a patient typically leaves the hospital within 24 hours and takes about one week to recover. This compares very favorably to the open method of surgery which requires three to five days of hospitalization and about three weeks of recovery time.
Approximately one to three percent of patients with symptomatic gallbladder disease require the open rather than the laparoscopic procedure. The reasons for the open procedure vary, but ultimately it comes down to what is safest tor the patient. At Brattleboro Memorial Hospital gallbladder operations are performed with two board certified surgeons present at the procedure. Laparoscopic operations are very safe but there is about a 1 in 1500 chance of injury to the bile duct. Having two surgeons in the operating room minimizes the risk even further as it allows them to confer with each other and agree on each step of the operation before proceeding. Should an open procedure become necessary both surgeons are needed to proceed in a safe manner for the patient.
Approximately half a million people have their gallbladders removed each year. Your body is perfectly capable of adjusting and functioning normally without the gallbladder for the rest of your life. If you are experiencing symptoms of gallstones or think you are at risk for gallbladder disease, talk to your primary care provider about getting an ultrasound. Like so many illnesses, early detection of gallbladder disease can help save your life.
Thomas H. Lewis, MD is a board certified surgeon with Brattleboro General Surgery, a department of Brattleboro Memorial Hospital. He can be reached at 802-251-8650.
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